Inflammatory Cytokines as Early Predictors of Weaning Failure From Extracorporeal Life Support

Weaning from extracorporeal life support (ECLS) in patients with refractory shock still remains a complex decision. Despite considerable advances in ECLS management, reliable biomarkers to predict weaning success are still not available. Inflammatory cytokines including interleukin-6 (IL6), interleukin-8 (IL8), and tumor necrosis factor-alpha (TNF-α) may reflect systemic immune response and have been proposed as potential predictors of deterioration or recovery.

A retrospective, single-center study analyzed 809 patients with ECLS between 2012 and 2024. Serum levels of IL6, IL8, and TNF-α were measured before ECLS and 24 h after initiation. Receiver operating characteristic (ROC) analysis and subgroup comparisons between clinical phenotypes were used to assess the cytokine predictive value.

Weaning was achieved in 66.9% of patients. IL8 levels after 24 h demonstrated the highest predictive accuracy for weaning failure (area under the curve AUC = 0.73), outperforming IL6 and TNF-α. The decline of IL8 levels during the first 24 h was associated (p = 0.008) with successful weaning. Subgroup analysis revealed that the predictive values of IL6 and IL8 were pronounced in patients with pulmonary embolism (AUC = 0.72, IL6) and septic shock (AUC = 0.77, IL8), with significantly elevated cytokine levels. Patients with structural heart disease (AUC = 0.85, IL6) and ventricular arrhythmias (AUC = 0.82, IL6) showed cytokine levels comparable to the whole cohort and a better prediction.

Among the evaluated cytokines, IL8 exhibited the strongest predictive benefit for weaning failure, especially on Day 1. Due to its early clearance dynamics, it may be a useful parameter in the appropriate clinical situation to achieve a better outcome.